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Home My WebLink About04-26-12 1505610140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 2aosol INHERITANCE TAX RETURN _ Harrisbum, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 2 5 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 2 1 8 2 0 1 2 0 6 1 3 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI R I D E R W I L L I A M E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^X 1. Original Return ~ 2. Supplemental Retum ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-62) 5. Federal Estate Tax Retum Required QX 6 Decedent Died Testate ~ death after 12-12-82) 7 D d M . . ece ent aintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E M c K N I G H T P - C P O M F R E T S T R E E T State ZIP Code P A 1 7 0 1 3 ~ REGISTE~ WILLS USE 6NLY ` -,-. ~...J r.,.7 :> i ~ ~`J ~ . .J '::x _ . r . ~ r~, c-~ ' _.} ?DAl'E FILED - . <"~ ,.._ ~~ ~~7 r ~~ r 7j ~: ,, _ ., s _- ti } ~•:: ~ _ ;-~ Correspondent's a-mail address: Under penaRies of pery'ury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. a~laPy[`+u~tt~VF_~tKS<N RESPON,ti~BJ,.E FOALING RETURN ~~~/` ADDRESS -~ 7 VALLEY STREET CARLISLE PA 17013 SIGNATUR R ARER OTI~R THAN PRESENTATIVE TE 7 ~~ ADDRE ~ 60 WEST P MF ET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: WILLIAM E- RIDER RECAPITULATION 8 8 0 0 0. 0 0 1. .......................................... Real Estate (Schedule A) 1 . 2. Stocks and Bonds (Schedule B) ..................................... . 2• ' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. 2 9 2 2 2 3. 4 4 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property (Schedule G) [3 Separate Billing Requested ..... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. S. 3 8 0 2 2 3 , 4 4 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9• 3 3 6 3 7. 4 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 2 4 8 5. 0 4 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 3 6 1 2 2 . 4 6 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 3 4 4 1 0 0 . 9 8 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 3 4 4 1 0 0. 9 8 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ O. D D 15. O. D 0 16. Amount of Line 14 taxable D 0 O 16 0. 0 0 . at lineal rate x .o _ . 17. Amount of Line 14 taxable 6 8 8 2 0. 2 0 17 8 2 5 8. 4 2 at sibling rate X .12 . 18. Amount of Line 14 taxable 2 7 5 2 8 D? 8 18 4 1 2 9 2. 1 2 at collateral rate X .15 . 19. .................................................... TAX DUE 19. .. 4 9 5 5 D• 5 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 150561024D 1505610240 4 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0259 DECEDENT'S NAME WILLIAM E. RIDER STREET ADDRESS 703 S. SPRING GARDEN STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1 ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 2,477.53 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 49, 550.54 Total Credits (A + g) (2) 2,477.53 (3) (4) 0.00 (5) 47, 073.01 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for Iffe of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ X^ 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)J. For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §9116(a)(1.3)J. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 4 REV-1508 EX+ (11-10) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: WILLIAM E. RIDER 21 12 0259 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. CITIZENS BANK -CHECKING ACCOUNT #6100634159 27,383.28 2. CITIZENS BANK -CHECKING ACCOUNT #6223613265 114,747.10 3. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6140744342 10,004.20 4. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6140875064 20,009.42 5. CITIZENS BANK -CERTIFICATE OF DEPOSIT #614087520 40,007.38 6. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6140889499 20,021.72 7. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6140889510 10,012.46 8. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6245539779 25,018.94 9. CITIZENS BANK -CERTIFICATE OF DEPOSIT #6245539787 25,018.94 TOTAL (Also enter on Line 5 Recapitulation) I $ If more space ~ needed, insert addfional sheets of paper of the same size a REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILLIAM E. RIDER 21 12 0259 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME, INC. 351.06 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) DAVID C. BOLDOSSER Street Address 7 VALLEY STREET Ciry CARLISLE State PA ZIp 17013-3174 Year(s) Commission Paid: 2, Attorney Fees: IRWIN & McKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 5 Accountant Fees: GROUPS TAX AND PAYROLL SERVICE INCOME TAX RETURN 6. Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA FIDUCIARY TAX RETURN 7. REGISTER OF WILLS -FILING FEE 8. CLOSING COSTS FROM SALE OF REAL ESTATE 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 10. THE SENTINEL -ESTATE NOTICE TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. 14,000.00 15,000.00 407.50 75.00 375.00 30.00 3,134.32 75.00 189.54 .42 REV-1512 EX+ (12-08) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESIDENT DECEDENT s ca i r~ i c ~r FILE NUMBER WILLIAM E. RIDER 21 12 0259 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VAOF DEADHTE 1. CARLISLE MEDICAL PATHOLOGY PC -MEDICAL , 18.37 2. CARLISLE HMA PHYSICIANS MGMT - MEDICAL 43.70 3. CHAPEL POINTE AT CARLISLE -NURSING 1,834.80 4. CUMBERLAND VALLEY NEPHROLOGY ASSOC., INC. -MEDICAL 56.40 5. PP&L -ELECTRIC 13.34 6. ROBERT C. CAIRNS, TAX COLLECTOR -PERSONAL TAXES 4.90 7. PINKER & ASSOCIATES - MECICAL 8.33 8. MILLENNIUM PHCY SYSTEMS MECHANICST -MEDICAL 123.88 9. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 324.07 10. THREE SPRINGS FAMILY PRACTICE -MEDICAL 57.25 TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same s¢e. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT tSIAI t VF: FILE NUMBER: WILLIAM E. RIDER 21 12 0259 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 91 f6 (a) (1.2).] 1. DAVID C. BOLDOSSER Sibling 68,820.20 7 VALLEY STREET 1/5TH REMAINDER CARLISLE, PA 17013-3174 2. CHARLES J. RIDER Collateral 68,820.20 903 ZANERS BRIDGE ROAD 1/5TH REMAINDER STILLWATER, PA 17878 3. PATTI BONBON Collateral 68,820.20 1223 PINE CREEK ROAD 1/5TH REMAINDER COBURN, PA 16832 4. KAY RUSSELL Collateral 68,820.19 7031 VETERANS WAY, PO BOX 65 1/5TH REMAINDER ICKESBURG, PA 17037 5. JOSEPH A. RIDER, SR. Collateral 68,820.19 29 S. MARKET ST., APT 6, PO BOX 124 1/5TH REMAINDER ELIZABETHVILLE, PA 17023 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ it more space is neeaeo, use aaaltlonal sneers of paper of the same size. r z WILL OF • ' WIiLLIAM E. RIDER I, William E. Rider of Cumberland County, Carlisle, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason c-f my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. I direct that my entire estate go to David C. Boldosser, Charles Rider, Patti Bason, Kay Russell and Joseph Rider Sr., in equal shares. B. Should David C. Boldosser, Charles Rider, Patti Boson, Kay Russeli or Joseph Rider Sr. predecease me, their share shall lapse and be divided into equal shares between the survivors. 4. I appoint David C. Boldosser, Executor of this my last Will. If David C. Boldosser should predecease me or cease tc, act in such capacity, I appoint Adca L. Boldosser as alternate. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN WIT ESS WHER F I have he unto set my hand this day of ~ , 2010. William E. Rider LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ~~~ ~ The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by -~~ William E. Rider as and for his last Will in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ~-, WITN S S~ -~rl~_ WITNESS LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 1 . . . i State of Pennsylvania County of Cumberland ss ., • .. I, William E. Rider, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. William E: Rider LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 Sworn to or affirm d ackn Rider the Testator, this ~~--~ day of _ NOTARUL SEAL >~plwn J.11o~g, Nagy pubac ~°' end Ca PA Mf- ~n++t'.ss9~ Expbr~ Sep~~ x'018 State of Pennsylvania ss County of Cumberland William E. We,~oi'o'~i,y 1y1. 1-bs}'e~'ferand _ ve ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. i<~e ~l1. ~,~y~r~prn to or a e ands bsc ''~d to bef me by witnesses, this day of , ~,p. WOTARIAL SEAL No ary P lic/Attorney S1epFwn J. Hogg Notary Publlc CarHale Boron CumbaNend Co. PA tey Com~ni F~rteo g a 2018 ACKNOWLEDGMENT FIDAVIT OMB Approval No. 2502-0265 •: A. Settlement Statement (HUD-1) .~.~` 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. ^ VA 5. ^Conv. Ins. BEARK3-12 C. Note: This forth is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown Items marked " " (p.o.c) were paid outside the closing; they are shown here for informational purposes and are not inGuded in the totals. D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender: KEITH E. BEAR, CARRI L. BEAR WILLIAM E. RIDER 91 RUSSELL ROAD, CARLISLE, PA 17015 703 S SPRING GRDEN STREET, CARLISLE, PA 17013 G. Property Location: H. Settlement Agent: I. Settlement Date: 03/09/2012 703 SOUTH SPRING GARDEN STREET I&M REAL ESTATE SERVICES, LLC Disbursement Date: 03/09y2012 Carlisle, PA 17015 West Pomfret professional Bldg, 60 West Pomfret Street South Middleton Township , Carlisle, PA 17013 Telephone:717-249-2353 Fax:717-249354 Place of Settlement: TitleExpress West Pomfret Professional Bldg, 60 West Pomfret Street, Printed 03/08/2012 at 2:09 pm Cadisle, PA 17013 by JMR X " a ,, 101. Contract sales P~ 88,000.00 401. Contract sales price gg,000.~ 102. Personal 402 . Personal 103. Settlement charges to borrower (line 1400) 1,397.44 403. 104. ~. 105. 405. Ad for Item selbr in advance Ad uabnenb for items id b seller in advance 1 O6. Citynown taxes ro 406. Citynown taxes to 107. County taxes to 407. County taxes to 108. School Taxes 03/09/2012 to 06/30/2012 263.09 408. School Taxes 0310912012 to 06/30/2012 ~3.pg 109. ~. 110. 410. 111. 411. 112• 412. 1~• • Gross Mpurrt Due from Borrower Y 89,060.53 ~ 420. Gross Arnaud Due to SeNer 88,283.09 • 201. Deposit or somas! nave Y 8,800.00 501. Excess deposit (see instructans) ~ ,~~ 202. Prindpal amount of new loan(s) 502. Settlement charges to seller (line 1400) 3,090,00 203. Existin loo s taken su ' to 503. Existin loo s taken su 'ect to 2~• 504. Pa of first m loan 205. 505. Pa off of serpnd mort loan 206. ~. 207. 507. 208. ~. 209. ~y Ad ustmerrb for items un id seler Ad uatmads for items un id b seller 210. Cityftawn taxes to 510. Cityftown taxes to 211. 212. County taxes Otn)1/2012 to 03!09/2012 Scholl Taxes to 44.32 511. 512. County taxes 01/01/2012 to 03/09/2012 Scholl Taxes to 44.32 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid Borrower G 8,844.32 520. Tool Rsductlon Amount Due Setlar 3.134.32 ross arraunt due from borrower (line 120) 301 302, Less amounts paid bynor borrower (line 220) 303. Cash ^X From ^ To Borrower ~~am a cummtlY v~lp OMB mnlml m,mEn. No canlgeMWilY a eswr 89,660.53 8,844.32 80,818.21 eq tlb ObdM,re is mmOMaY. TMa 601. Gross amount due to seller (line 420) 602. Less reductions in amount due seller line 520 603. Cash ^X To ^ From Seller bC-IpwO ro puYiOa Ike PM~ks lo. NE9PA mvaW bansvtlion wpb inbrmalbn Ewing t M gg'2~:Og 85,128.77 Previous editions are obsolete Page 1 of 4 HUD-1 1 Y 7ulr' :[rEt0aurtBrirt~KEeet _ Paid Frorn Raid~From Division oFoomrrllaslort lid ~sfolbws: BorrotNer's Seller s 701. $o.~ to Funds at Fexnds'at 702. $o.oo ro 703. Commission paid at settlement .Settlement Sef>le~nent !100. .ibms. in:Caan~llonkwlgi+Lalr: 801. Our origination charge (Includes Origination Point 0.000% or $0.00) $ (from GFE #1) 802. Your credit or charge (points) for the speafic interest rate chosen $ (from GFE #2) 803. Your adjusted originaton charges (from GFE A) 804. A sisal fee to from GFE #3 805. Credit rt to from GFE #3 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 808. to .900. <Ibma . . , :...;. 901. Daily interest charges from from 03109/2012 to 04101!2012 $O.OOIda y (from GFE #10) 902. Mort a insurance ium months to from GFE #3 903. Homeowner's insurance months to from GFE #11 904• months to from GFE #11 :1000:. .:. ,.. :.. .. ~, ' 1001. Initial deposit for your escrow account (from GFE #9) 1002. Homeowner's insurance months $ !month 1003. Mort a insurance months $ /month 1004. Pro taxes months $ !month 1005. County taxes months $ 19.88/month $ to 1006. Assessments months $ 70.39/month $ to 1007. Aggregate Adjustment $ to 1101. Title services and lender's title insurance from GFE #4 132.00 10.00 1102. Settlement or cbsing fee to IRWIN & MCKNIGHT, P.C $125.00 1103. Owners title insurance from GFE #5 1104. Lenders title insurance $ 1105. Lender's title policy limit $0.00 1106. Owner's title policy limit $88,000.00 1107. Agent's portion of the total title insurance premium $ 1108. Underwriter's portion of the total title insurance premium $ 1109. 100:'' ., .... . 1201. Government recording charges $ (from GFE #7) 62.00 1202. Deed $62.00 Mort e $ Release $ to Recorder of Deeds 1203. Transfer taxes $ (from GFE #8) 8!30.00 1204. City/County taxlstamps Deed $880.00 Mort e $ to Recorder of Deeds 1205. State Tax/stamps peed $680.00 Mort $ to Recorder of beds 880.00 1206. Deed $ Mort $ to 7300..:, _, .. .~, ,.. mw.... ~ 1301. Required services that you pn shop far (from GFE #6) 323.44 1302. to 1303. Auction fee to ROWE AUCTION SERVICE $ 2,200,0 1304. 2012 CORWP TAXES to ROBERT CAIRNS, TAX COLLEC $238.57 1305. FINAL WTR/SWR #00901260 to SMTMA .87 r~ ' ' ''~ ~ ~ 1,397.44 3,090.00 aw cuw,~c u~ wwiny ur ~oNn~nc~, i~~~,c, t~~a,ue,, ptnvesrur, orotnfec --arson oy ienaer snows on page i. "'credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-1 Loan Terma i o.~ o.~ o.oo o.~ o.oo o.oo o.oo ~o.~ o.~ sz.oo o.oo ,32.00 o.~ a.~ o.~ o.oo 0.00 238.57 0.00 84.87 0•~ 517.44 $ 517.44 or 999.9999% nuts: ~~ you nave any quessons aoout me Settlement c:narges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement KEITH E. BEAR CARRI L. BEAR WILLIAM E. RIDER DAVID C. BDLDOSSER, EXECUTOR ~ ~ ~ g ~~~ The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have ceused or will cause the funds to be disbursed in accordance with this statement. .~ ~ 0~ ~8 ~? ~ 2 SETTLEMENT AGENT ~ DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 rr -. Name of Borrower: Name of Seller: File Number: Prepared 03108/2012 at 2:09 pm Note: This page displays an itemization of the credits shown in section 200 of the HUD-1 Settlement Statement This page accompanies but is not a part of the HUD-1 Settlement Statement If a discrepancy exists, the information on the HUD-1 Settlement Statement applies. Credits Credk • Name of Borrower: KEITH E. BEAR CARRI L. BEAR Name of Seller: WILLIAM E. RIDER File Numtrer: BEARK3-12 Prepared 0310812012 at 2:09 pm Note: This page displays an itemization of the adjusted origination charges shown in section BO0 of the HUD-1 Settlement Statemen This page accompanies but is not a part of the HUD-1 Settlement Statement If a discrepancy exists, the information on the HUD-1 Settlement Statement applies. Your Loan Origination Charges Borrower SNkr 801. Our origination charge (Indudes Origination Point 0.000% or $0.00) to $ 0.00 802. Your credit or charge (prints) for the sperif~c interest rate chosen to $ 0.00 803. Your adjusted origination charges 0.00 0.00 . ~ r Name of Borrower: KEITH E. BEAR CARRI L. BEAR Name of Seiler: WILLIAM E. RIDER File Number. BEARK3-12 Prepared 0310812012 at 2:09 pm Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement This page accompanies but is not a part of the HUD-1 Settlement Statement If a discrepancy exists, the information on the HUD-1 Settlement Statement applies. 1100: TiIN!'t'hugras 1101, Title services and lenders title insurance Tota~Aa~ to Borrorrar , NOTARY to $ 7.00 7.00 NOTARY to $ 10.00 10 1102. Settlement or dosing fee to IRWIN & MCKNIGHT, P.C. $ 125.00 125.00 1104. Lender's Gde insurance to $ 0.00 Totals: S 142.00 0.00 132.00 10. Sa0r+ritandererodNs~shaiwnon 1 P,OC;~PaidOubidsr ~l:R~~tatdalC(tlsilit Previous editions are obsolete Page 1 of 1 HUD-1 >~ Citizens Bank March 15, 2012 Law Offices Irwin & McKnight PC Attn Roger B Irwin West Pomfret Professional Bldg 60 West Pomfret St Carlisle PA 17013-3222 Estate of William E Rider Date of Death: Feb 18, 2012 SSN: 206-10-9919 One Citizens Drive ROP112 Riverside, RI 02915 ~'L ,- F'4;NPJ ~: ivicKl`IG!1 !~uu ;~~=~r~= Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his/her date of death. Asper your request, the decedent did not have any accounts that were closed within one year of date of death. For Installment Loans or Line of Credit accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-877-579-2667 Decedent Account REF#: 536294 .' w '~ Citizens Bank- Account Number 6100634159 Account Title William E Rider Date O ened 4/5/1999 Account T e Checkin Princi al Balance as of DOD $27382.40 Interest from Last Postin to DOD $ .gg Account Balance as of DOD $27383.28 YTD Interest to DOD $1.09 Citizens Bank° Account Number 6223613265 Account Title William E Rider Date ened 12/10/2008 Account T e Checkin Principal Balance as of DOD $114739.58 Interest from Last Postin to DOD $7,52 Account Balance as of DOD $114747.10 YTD Interest to DOD $9.70 Citizens Ban~CM Account Number 6140744342 Account Title William E Rider Date ened 7/30/1999 Account T e Time D osits Princi al Balance as of DOD $10000.00 Interest from Last Postin to DOD $4.20 Account Balance as of DOD $10004.20 YTD Interest to DOD $5.93 .,~' , Citizens Bank° Account Number 6140875064 Account Title William E Rider Date O ened 5/29/1990 Account T e Time D osits Principal Balance as of DOD $20000.00 Interest from Last Postin to DOD $9.42 Account Balance as of DOD $20009.42 YTD Interest to DOD $12.71 Citizens Bank Account Number 614087520 Account Title William E Rider Date ened 9/12/1991 Account T e Time D osits Princi al Balance as of DOD $40000.00 Interest from Last Postin to DOD $7.38 Account Balance as of DOD $40007.38 YTD Interest to DOD $50.86 ~, t Citizens Bankn Account Number 6140889499 Account Title William E Rider Date ened 4/5/1990 Account T e Time D osits Principal Balance as of DOD $20010.00 Interest from Last Postin to DOD $11.72 Account Balance as of DOD $20021.72 YTD Interest to DOD $45.48 ~ • ~-` tit~zens Bank Account Number 6140889510 Account Title William E Rider Date O ened 5/3/1990 Account T e Time D osits Princi al Balance as of DOD $10010.00 Interest from Last Postin to DOD $2.46 Account Balance as of DOD $10012.46 YTD Interest to DOD $g 49 ~ • t ~- a titizens Bank" Ac n Number Account Title Date erred Account T e Princi al Balance ~ of DOD Interest from~LCeta of DOD Account Bal YTD Interest to DOD 6245539779 William E Rider 1/7/2005 Time Deposits $25000.00 $18.94 $25018.94 $83.94 ~ ~ y~ +,~ Utizens Bank' Account Number 6245539787 William E Rider Account Title 1 /7/2005 Date ened Time Deposits Account T e Principal Balance as of DOD $25000.00 Interest from Last Postin to DOD $18.94 Account Balance as of DOD $25018.94 YTD Interest to DOD $83.94 - - ---- ~_ ~ s -------------------------- ------ - - - - -------- pays!. - ---------- CHARGES CREDITS ALANCE DESCRtPTfON ~ `DATE Units 2,727.80 ,~ Balance Forward 29 3,596.00 -868.20 02/01/2012 Room and Board -Personal Care 02/01-02/29 3 12.00 -856.20 02/03/2012 Tra sportation ialysis 1/30, 2/1, 2/3 00 744 -112.20 02/06/2012 oom and Board -Personal Care 6 . 02/01-02/06 4 16.00 -96.20 02/07/2012 Transportation Dr. Hotchner 3 12.00 -84.20 02/10/2012 Transportation Dialysis 2/6, 2/8, 2/10 4 16.00 -68.20 02/14/2012 Transportation Dr. Hotchner 2 8.00 -60.20 02/15/2012 Transportation Dialysis 2/13, 2/15 02/17/2012 Room and Board Private-HC 02/11-02/17 7 1,855.00 1,794.80 80 834 1 10 40.00 . , 02/20/2012 Transportation Death Cert. to Dr. Dell RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 13347 0.00 1,834.80 0.00 0.00 0.00 $1,834.80 Form PB-01 RESIDENT NAME Mr. William E. Rider CHAPEL POINTE AT CARLISLE, 770 SOUTH HANOVER STREET, CARLISLE, PA 17013-4105 • ~- ;. :. y~ z February 27, 2012 David C. Boldosser 7 Valley St. Carlisle, PA 17013 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 The Funeral Service for William E. Rider We sincerely appreciate the confidence you have placed in us and will contin feel free to contact us if o h y u ave any questions in regard to this statement ue to assist you in eve wa rY y we can. Please . THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES AND MERCHANDISE THAT YOU SELECTE AU TOMOTIV , E EQUIPMENT, D WHEN MAKING THE FUTVERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Basic Services of Funeral Director/Staff Bathing & Embalming ~ $1200.00 Dressing, Casketing, Cosmotology etc. $895.00 2. FACILITIES/SERVICES/STAFF/EQUIPMENT ~- $250.00 Basic Use of Facility • , ' Document Prep/Permanent Recording, ~ $130.00 Obituary Prep/Review ~ ~ $250.00 Facility Usage for Viewing/Funeral ~ $75.00 Staff Usage for Viewing/Funeral $300.00 Staff for Graveside/Interment Service ~ $300.00 3. AUTOMOTIVE EQUIPMENT $100.00 Vehicle to transfer remains to Funeral Home Hearse (Casket Coach) ~ $275.00 Safety Lead/Clergy Car $275.00 Utility Car , $125.00 FUNERAL HOME SERVICE CHARGES $125.00 SELECTED MERCHANDISE: $4300.00 1170FC Silver NG Casket 20G. # 12 Guardian in Silver Painted ~ $950.00 Acknowledgement cards, ~ $1395.00 Register Book(s) $10.00 Memorial folders , ~ ~ $40.00 Burial clothing, ~ ~ $75.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $275.00 Cash Advances $7045.00 Opening Grave• • Sentinel Obituary w/Photo $1826.00 Certified Copies of Death Certificate ~ Clergy Honorarium ~ $120.43 $18.00 Flowers, $100.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . Total $132.50 $2196.93 Total Cost . . . . . . . . . . . . . $9241.93 i++ _ , r +r ~~ ,~ a ~f a SUB-TOTAL • INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE The unpaid balancg over 30 days is subjected to a 1.50 % service chazge per month - 18.0000 % per annum. $9241.93 0.00 $9241.93 ,~~P/~tS ~ ~tJd~ ~d/P/~ O ~' ~i °~ I~ CdVPIPC~ ~` ` c~~r~~-. ~~ ~.~, ~ o ~ e,~a ~-, C' Lasi e~ ~ ~~ ~ ~ _ ~~~ ~3~ ~a = ~ ~ ~i o g~ ~ ~~ 7q , ~~a~.~3=~~°- Rsi. a6 ~jc,.~ ~~ `3~e~- ~~ r ~ ~~ d ` ~a ~?1~0 p~~~ ~~~~ ~~~ 1 a ~ ~eCei~D ~~~1~ a~